Secondary Dysmenorrhea Causes and Symptoms

Dysmenorrhea

• Primary dysmenorrhea: unknown cause, usually occurs in women under 20 years old
• Secondary dysmenorrhea: caused by underlying conditions, such as endometriosis, adenomyosis, or pelvic inflammation

Causes of Secondary Dysmenorrhea

• Cervical stenosis: severe narrowing of the cervical canal, can be congenital, due to cervical injury, or inflammatory process
• Endometriosis: ectopic endometrial tissue outside the uterus, affecting 6-10% of reproductive-age women, with 70-80% experiencing chronic pelvic pain
• Adenomyosis: endometrial glands and stroma in the myometrium
• Pelvic inflammation: caused by gonorrhea, chlamydia, or other microbes, leading to chronic pelvic pain in up to 30% of women
• Pelvic congestion syndrome: engorgement of pelvic vasculature, causing chronic pelvic discomfort worsened by prolonged standing and intercourse

Diagnosis

• History and physical exam
• Diagnosis of cervical stenosis: external os appears scarred, impossible to pass a cervical Pap smear brush or uterine sound

Treatment

• Pharmacologic: NSAIDs, tocolytics, OCPs
• Non-pharmacologic: exercise, heat, behavioral therapy, dietary changes
• Surgical: dilatation and curettage, vaginal delivery

Premenstrual Syndrome and Dysphoric Disorder

• Premenstrual syndrome: affects 3-8% of women, with family history, personal past or current psychiatric illness, and history of alcohol abuse or postpartum depression
• Premenstrual dysphoric disorder: affects 2% of women, associated with lower education, major depression, smoking, and other factors

Treatment for Premenstrual Syndrome and Dysphoric Disorder

• Diet, supplements, and lifestyle changes: increasing complex carbohydrate intake, vitamin B6 supplement, regular exercise, and other therapies
• Psychoactive drugs: SSRI as first-line treatment, with rapid onset of action and effectiveness in approximately 60% of women
• Other treatments: OCPs, NSAIDs, diuretics, bromocriptine, GnRH agonists, and surgery

This quiz covers the symptoms, pathogenesis, and treatment of secondary dysmenorrhea, including cervical stenosis. Learn about the causes and effects of this gynecological condition.